ultrasensative PSA test?

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WhiteSoxFan - 19 Feb 2007 19:51 GMT

I know what an ultrasensative PSA test is. My HMO (BCBS of Illinois)
doesn't do them as standard procedure for my 3 month screening. What's
the difference in price? If its not too expensive, maybe I can pop for
the difference. I sort of would like to start doing them to perhaps
get the jump on treatment, even if its stuff that the medical
establishment would frown upon if the ol PSA starts to act up. I see
the Onc tomorrow for my one year anniversary check up.

WSF

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Steve Jordan - 21 Feb 2007 00:14 GMT

On February 19, WSF wrote:

> I know what an ultrasensative PSA test is. My HMO (BCBS of Illinois)
> doesn't do them as standard procedure for my 3 month screening. What's
> the difference in price? If its not too expensive, maybe I can pop for
> the difference.

It is my understanding that the charge is ~$35, but Medicare pays 100%
so I might be mistaken.

> I sort of would like to start doing them to perhaps
> get the jump on treatment, even if its stuff that the medical
> establishment would frown upon if the ol PSA starts to act up. I

The only contrary reason I have heard (from an expert in the field) is
that the US PSAs might cause a pt to develop a case of nerves if the
result floats (or "twitches") a bit from test to test. I reckon that
that's correct, if the pt is relatively unsophisticated and his medic
won't take the time to explain.

WSF is correct: the US tests can give a pt and his medic early warning
if the wheels begin to fall off.

See: Shen S., et al., "Ultrasensitive serum prostate specific antigen
nadir accurately predicts the risk of early relapse after radical
prostatectomy." PubMed ID number 15711268.

Also see the related articles listed on the right side of the page.

PubMed is at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

Regards,

Steve J

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Leonard Evens - 21 Feb 2007 15:05 GMT

> I know what an ultrasensative PSA test is. My HMO (BCBS of Illinois)
> doesn't do them as standard procedure for my 3 month screening. What's
[quoted text clipped - 5 lines]
>
> WSF

I don't claim to be an expert, but it is my impression that the issue of
whether or not ultrasensitive testing is worth it is still unsettled.
Many authorities claim that there is no point in doing anything until
PSA levels reach something like 0.2 ng/ml, while other think that
recognizing a trend at very low levels may be useful in some cases in
initiating follow up treatment. I think how people come down on this
issue is based in large part on whether or not they think very early
intervention is valuable. Personally, I don't think it is. I accept
the argument that there is not much to be gained by initiating either
radiation or hormone therapy at those levels. My doctor doesn't use the
ultrasensitive tests, and I think he has saved me from much needless
anxiety by that decision.

You have to look at the evidence and decide whether 'getting the jump'
would be worth it for you. Remember when considering this that the
follow-up treatment also may have unpleasant side effects, so there
should be a strong case for initiating it early. On the other hand, if
you are specially rational---which few of us are---you may feel that
just having the information will be useful even if you wait to act on it.

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WhiteSoxFan - 21 Feb 2007 15:21 GMT

Here's my follow up. I saw my Onc yesterday-latest blood work came
back aces, non sensative test-and I asked him. He pretty much echoed
what has been discussed here. I rationalized away from the ultra due
to the fact that it should have been done at the first post-op blood
test to get a true base-line.

Thanks for your replys,

WSF

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Steve Kramer - 22 Feb 2007 20:03 GMT

> Here's my follow up. I saw my Onc yesterday-latest blood work came
> back aces, non sensative test-and I asked him. He pretty much echoed
> what has been discussed here. I rationalized away from the ultra due
> to the fact that it should have been done at the first post-op blood
> test to get a true base-line.

Congratulations!

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Steve Kramer - 22 Feb 2007 20:00 GMT

> I don't claim to be an expert, but it is my impression that the issue of
> whether or not ultrasensitive testing is worth it is still unsettled. Many
[quoted text clipped - 7 lines]
> therapy at those levels. My doctor doesn't use the ultrasensitive tests,
> and I think he has saved me from much needless anxiety by that decision.

I agree, though not necessarily across the board.

I would opine that ultra sensitive testing may be of some use to the doctor
wary of patterns. It woudl cause no anxiety in most. I think none of us
new the difference between .02, .04, .08 and .016 before we were dx'd and
researched things.

After surgery, it would probably be a good idea for 18 months to determine
the liklihood of recurrence.

After recurrence, I just don't see much use in it.

Although, I must admit that last <0.04 was better by far than previous <0.1
PSAs.

Signature

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA .1 .1 .1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04
Non Illegitimi Carborundum

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